PREPARATION OF THE SURGICAL TEAM
Surgical personnel are a major cause of microbial contamination during
surgery. Careful preparation of the surgical team and nonsterile personnel reduces
the number of bacteria in the surgical suite but does not eliminate them.
Since there is correlation between the number of people, their movement
and the number of airborne bacteria in a surgical suite, if it is possible,
surgical room personnel should be reduced to only those essential for
anesthesia and surgical support.
- Step 1 Surgical attire
Everybody who is entering the operating room suite should be
appropriately clothed, regardless of whether surgery is in progress. To
minimize microbial contamination from operating room personnel, should wear
scrub clothes rather than street clothes (picture 1).
Picture 1. Scrub clothe
Nonscrubbed personnel should wear long-sleeved jackets over their scrub
clothes.
- Step 2 Shoe covers
Any footwear that is comfortable can be worn in the surgery area. Shoe
covers should be donned when first entering the surgical area and should be
worn when leaving it to keep shoes clean.
Picture 2. Shoe covers
- Step 3 Hair covering and masks
Hair is significantly carrier of bacteria so it should be completely
covered with surgical cap. Masks should cover the mouth and nostrils (picture
3). Major function of mask is to filter and contain droplets of microorganisms
expelled from the mouth and nasopharynx during talking, sneezing and
coughing.
Picture 3. Wearing cap and mask
- Step 4 Surgical scrub
The surgical scrub is a procedure for cleaning the hands and forearms to
reduce the number of bacteria that come in contact with the wound through
scrubbed personnel during surgery.
All sterile surgical team members perform a hand and arm scrub before
entering the surgical suite.
Of the commonly used surgical hand scrub solution, chlorhexidine gluconate has the
greatest residual activity and persistence. Combining an alchocol preparation
with chlorhexidine gluconate is the most effective means of reducing microbial
counts.
Once the scrubbing has been started, nonsterile items cannot be handled.
When the scrub has been completed, the hands and arms should be dried with a
sterile towel.
Total scrub time is 2 3 minutes per hand and arm.
► How to wash hands and arms ◄
NOTE:
- Watches and rings should be removed before scrubbing because they
are reservoirs for bacteria.
- Fingernails should be free of polish and trimmed shortly and cuticles
should be in good shape.
- Never allow your fingertips to come below the level of your elbows.
- Never shake your hands to get rid of excess water; allow the water
to drip from your elbows.
- Hold your hands upright and in front of you and proceed to the
gowning and gloving area.
- Step 5 Gowning
Gowns serve as a barrier between the skin of the surgical team member
and the patient. They are available as disposable (single use) or reusable.
Gowns are folded so that the inside of the gown faces outward. Once you
take gown, do not shake it because this increases the risk of contamination.
When you wear gown keep your hands within the cuffs. Have an assistant
pull the gown up over your shoulders and secure it by tying neck ties and tying
the inside waist tie. If a sterile-back gown is used, do not secure front tie
until you have sterile gloves on hands (picture 4).
Picture 4. Securing front tie
- Step 6 - Glowing
Glowing can be preformed:
- Gloving yourself
using:
b)
open method
- Assisted gloving
(picture 4)
Picture 4. Assisted gloving
Maintaining sterility during surgery
Once gowned, the surgical team members should always face the sterile field
and should not touch or lean over a non-sterile area. Also should avoid
changing the position level. The arms and hands should remain above waist and
below shoulders levels. The arms should be clasped in front of the body, above
waist.
REFERENCE:
- Theresa Welch Fossum; Small Animal Surgery (second edition); 2002
Mosby;